Ultrasound guides soft tissue foreign-body extraction
MedWire News: The use of ultrasound can help physicians remove foreign objects that have penetrated the soft tissue as a result of an accident, research shows.
Overall, the ultrasound-guided extraction of foreign bodies was successful in 88% of patients.
"There is a steep learning curve but knowledge of pitfall avoidance yields greater success and reduces procedural time," reports Mike Bradley (Southmead Hospital, Bristol, UK) in Clinical Radiology.
Radiography may be used in the emergency department to identify radiopaque material embedded in soft tissue, such as metal, glass, and some plastics. However, ultrasound has the advantage of being able to image all types of materials, including organic materials that might lead to septic complications or infected wounds.
In his report, Bradley describes his experiences with 350 prospective patients referred for ultrasound imaging for foreign-body diagnosis and percutaneous removal.
Most foreign bodies were lodged in the feet or hands and included such items as splinters, glass, needles, metal, sea urchins, air gun pellets, maggots, and pencil lead.
Patients with a negative ultrasound were discharged, while some patients were deemed unsuitable for percutaneous removal, such as those with objects under the nail bed, objects in the joint synovium, objects adjacent to the digital artery or nerve, or foreign bodies embedded deep within the muscle.
In total, Bradley successfully removed 252 (88%) foreign bodies. Of these, 45 objects were superficial, and were extracted without continuous ultrasound guidance. In the remaining 207 patients, continuous ultrasound was used to remove the objects, as well as intermittent fluoroscopy in 19 patients with metal objects embedded.
The procedure was tolerated well by patients, including those younger than 16 years of age, and procedural times ranged from 5 to 40 minutes (mean time was 15 to 20 minutes).
Bradley explains that the ultrasound probe was used to "fix" the foreign body so that it could be removed with forceps or a needle, depending on size.
"Hard materials gave positive feedback and so were usually quicker to extract," notes Bradley. "The soft splinters often did not give feed back to the instrument and as well as being more mobile, led to longer procedures or lack of success."
Objects lodged under the nail bed were not sufficiently visualized with ultrasound, he adds, and these patients were referred for surgery.
By MedWire Reporters